Background and purpose:During recent years, the incidence of papillary thyroid micro-carcinoma (PTMC) has increased year by year. There are many differences in its diagnosis and treatment. This research investigated and summarized the clinical diagnosis and treatment of thyroid papillary carcinoma by means of analyzing the patients’ data.Methods:Sixty-one cases underwent high resolution ultrasound examination before operation, and the accuracy rate was 86.9%. All patients underwent surgical treatment. Thirty-nine patients had thyroid lobectomy and ipsilateral central lymph node dissection (CLND), 11 underwent concurrent partial thyroidectomy, 22 had total thyroidectomy and bilateral central lymph node dissection and 5 underwent concurrent cervical lymph node dissection. The incidences of central and cervical lymph node metastasis were 44.3% and 8.2%, respectively. Univariate analysis showed that the risk factors for central lymph node metastasis were age <45 years, multifocality, tumor location near or across the midline, tumor diameter≥5 mm. The rates of central lymph node metastasis were 66.7%, 60.7%, 66.7% and 53.8, respectively.Conclusion:High resolution ultrasound examination has a high sensitivity for the detection of PTMC. It is important to implement standardized and individualized treatment plan to the patients with PTMC.

Objective To conduct one-visit or multi-visit root canal treatment for infected root canals ,to observe and analyze the postoperative pain and the periapical healing status and to evaluate the clinical application of one -visit root canal therapy .Meth-ods 80 teeth diagnosed as chronic apical periodontitis were recruited .40 cases were included in one-visit root canal treatment group and the other 40 cases in multi-visit group with calcium hydroxide as an interapoinment medicament .Main clinical assessments in-cluded postoperative pain ,postoperative X ray and 6 months′periapical healing response .Results There there was no statistically significant difference between the groups regarding postoperative pain (one-visit group 37 .5% ,multi-visit 35 .0% ,P>0 .05) and 6 months′periapical healing response(one-visit group 81 .6% ,multi-visit 80 .6% ,P>0 .05) .Conclusion One-visit root canal treat-ment has the same clinical effect(postoperative pain and periapical healing ) as multi-visit on infected root canals and has the clinical feasibility of routine use .

Objective To detect the expression of the transcription factor CCAAT/enhancer-binding protein alpha (C/EBP-α) in the epidermis of psoriasis vulgaris lesions,and to investigate its correlation with abnormal keratinocyte proliferation and disease severity.Methods Biopsy specimens were obtained from the lesions of 30 patients with psoriasis vulgaris and normal skin of 30 healthy human controls.A two-step immunohistochemical procedure was performed to detect the expressions of C/EBP-αt and Ki-67 in these specimens,and Western blot to quantify the expression of C/EBP-α.The proliferation index of keratinocytes was calculated according to the expression intensity of Ki-67.Statistical analysis was carried out by using the SPSS 17.0 software,and Pearson correlation analysis was conducted to assess the relationship of C/EBP-α expression level with proliferation index of keratinocytes and psoriasis area and severity index (PASI) score.Results C/EBP-α was predominantly expressed in the cytoplasm of keratinocytes,while Ki-67 in the nuclei of keratinocytes.Compared with the normal skin,the psoriatic lesions showed a significantly lower expression of Ki-67 (t =7.82,P ＜ 0.05),but higher proliferation index of keratinocytes (t =4.54,P ＜ 0.05).The expression level of C/EBP-α was negatively correlated with the proliferation index of keratinocytes and PASI score in the patients (both P ＜ 0.05).Western blot also showed an obvious decrease in the expression of C/EBP-α in psoriatic lesions.Conclusions The expression of C/EBP-α is decreased in lesions of psoriasis vulgaris,which might be involved in the pathogenesis of psoriasis vulgaris.

Objective To evaluate the performance of D-dimer in the differential diagnosis between acute aortic dissection (AAD)with elevated troponin-I(TNI)and acute myocardial infarction (AMI) in patients with acute chest pain diseases with elevated TNI.Methods The data of the 547 patients complaining acute chest pain who were diagnosed as acute myocardial infarction by thoracic and abdominal aorta CTA examination from January 2013 to September 2015 were analyzed.The comparison of data of D-dimer mass concentration and the general clinical information between 44 patients diagnosed as AAD with elevated TNI and without other underlying diseases which could cause increase in D-dimer mass concentration(AAD with elevated TNI group) and 50 patients diagnosed as acute myocardial infarction confirmed by using coronary angiography(AMI group) were carried out.Results Compared with AMI group,in the AAD with elevated TNI group,the type of Stanford A was 38 cases, accounting for 86.4%;the proportion of the patients with a history of hypertension was higher, and the average age was younger;the D-dimer mass concentration levels and the positive ratio of the D-dimer test were much higher[11.27 μg/mL(3.95,20)μg/mL vs.0.28 μg/mL(0.22,0.40)μg/mL,P<0.01;100%vs.14%,P<0.01.The area under the ROC curve to diagnosis of the AAD with elevated TNI was 0.997,and the optimal diagnostic threshold was 1.095 μg/mL.When the D-dimer mass concentration level was 1.095 μg/mL,the sensitivity,specificity,positive predictive value(PPV),negative predictive value(NPV),positive likelihood ratio(PLR),negative likelihood ratio(NLR)were 97.7%,98%,97.7%,98%,48.86,and 0.02,respctively.When the D-dimer mass concentration level was 0.5 μg/mL,which meant the D-dimer test was positive,the sensitivity,specificity,PPV,NPV,PLR,NLR were 100%,86%,86.3%,100%,7.14,and 1.16,respctively.Conclusion D-dimer is helpful to the differential diagnosis between the AAD with elevated TNI and the AMI in acute chest pain patients with elevated TNI.

The purpose of this study was to investigate the pharmacokinetic interaction between sunitinib and ramipril in rats. Eighteen male SD rats were divided into three groups, with each group being assigned to orally receive sunitinib, ramipril, sunitinib and ramipril, respectively, for ten days. Blood samples were collected at dif-ferent times after first-day and tenth-day administration. The concentrations of ramiprilat and sunitinib in rat plasma were determined by LC/MS/MS and the pharmacokinetic parameters were calculated and statistically analyzed. Compared with the administration of ramipril alone, after a single-dose combined administration, tmax of ramiprilat decreased significantly and t1/2 prolonged, while AUC0-∞ remained unchanged. These results indicated that the ab-sorption rate of ramiprilat increased and the elimination rate decreased, but total absorption degree was not changed. After multiple-dose administrations, CL of ramiprilat decreased and AUC0-∞ increased obviously. It sug-gested that accumulation of ramiprilat occurred in body and the drug elimination became slower. No obvious difference of sunitinib pharmacokinetic behavior was found when it was given in combination with ramipril after a single-dose administration or multiple-dose administration. Sunitinib decreased the elimination of ramiprilat after co-administration in company with drug accumulation in body after multiple-dose co-administration. The study showed that there were pharmacokinetic interactions between sunitinib and ramipril in SD rats.

Objective To study the adsorption effect of activated charcoal suspension on paraquat (PQ) in gastrointestinal tract of beagles exposed to PQ.Methods Twenty healthy male beagles were randomly divided into experimental group and control group,with 6 beagles in each group.20％ PQ solution (a dose of 30 mg/kg) was prescribed through stomach for beagles in both groups.After exposure to PQ for 30 minutes,the beagles in experimental group were given activated charcoal suspension (1.0 g/kg of type Ⅰ activated charcoal powder mixed with 100 mL of normal saline) by gavage,while the control group was only given equal volume of normal saline.After exposure to PQ for 10 minutes,30 minutes,and 1,2,4,8,12,24,and 48 hours,blood was collected from hepatic portal veins and peripheral veins to detect the PQ concentration change in the plasma.The toxicokinetics software DAS 2.1.1 was applied to analyze PQ concentration and compare the change in toxicokinetics parameters between the both groups.The change in vital signs including heart rate (HR),respiratory rate (RR) and pulse oxygen saturation (SpO2) was dynamically monitored 10 minutes before exposure,4 hours and each day from the 1st to the 7th day after exposure.Results After exposure to PQ,the poison concentration in the plasma of hepatic portal veins and peripheral veins in the control group rose quickly and reached peak 4 hours later.It fell quickly at first,and fell slowly 8 hours later.But in the experimental group,the increase rate to the peak was significantly slow.Besides,PQ peak fell more obviously than that in the control group and it was about 50％ of the control group (μg/L:123.50 ± 11.67 vs.255.18 ± 12.29 in blood from hepatic portal veins,122.35± 11.72 vs.250.86± 11.15 in blood from peripheral veins).After 8 hours it fell much more quickly than that of the control group.After exposure to PQ for 48 hours,PQ concentration in the plasma was still lower than that of the control group (μg/L:0.53 ± 0.18 vs.15.98 ± 5.58 in blood from hepatic portal veins,0.31 ± 0.01 vs.15.03 ± 4.82 in blood from peripheral veins,both P ＜ 0.01).With the toxicokinetics analysis,compared with the control group,the maximum concentration (Cmax) and area under the curve (AUC) of PQ in the plasma of hepatic portal veins and peripheral veins in the experimental group were significantly decreased [Cmax (μg/L):125.07 ± 9.49 vs.255.18 ± 12.29 in blood from hepatic portal veins,123.38 ± 9.52 vs.250.86 ± 11.15 in blood from peripheral veins;AUC (mg· L-1· h-1):1.6±0.2vs.3.3 ± 0.4 in blood from hepatic portal veins,1.5 ± 0.2 vs.3.2 ± 0.3 in blood from peripheral veins],time to the peak (Tmax) of PQ was slowed (hours:5.3 ± 1.9 vs.4.0 ± 0.0 in blood from hepatic portal veins,4.7 ± 1.5 vs.4.0 ± 0.0 in blood from peripheral veins),and PQ plasma half-life (t1/2) and mean retention time (MRT) were significantly shortened [t1/2 (hours):3.8 ± 1.2 vs.15.4± 3.7 in blood from hepatic portal veins,3.5 ± 1.0 vs.15.5 ± 2.7 in blood from peripheral veins;MRT (hours):8.0± 1.5 vs.13.4± 1.2 in blood from hepatic portal veins,7.6± 1.3 vs.13.3± 1.2 in blood from peripheral veins;all P ＜ 0.01].After exposure to PQ,HR and RR in both the experimental group and the control group increased and reached to the peak about the 4th day and then the increase rate began to slow down gradually;SpO2slowed down gradually and reached to the valley about the 4th day and then it began to recover,but the change range of vital signs in the experimental group was smaller than that of the control group,and the parameters were significantly better than those of control group [4-day HR (bpm):134.50±3.00 vs.142.00±6.43,4-day RR (times/min):31.00±0.58 vs.34.33±0.94,4-day SpO2:0.900±0.006 vs.0.873±0.005,all P ＜ 0.05].Conclusion Activated charcoal administrated at 30 minutes after PQ poisoning can slow down the increase rate of PQ concentration in the plasma,decrease the peak concentration and has less influence on vital signs in beagles.

Objective To evaluate the long-term efficacy of recombinant human endostatin (rh-Endo) combined with FOLFOX4 as an adjuvant treatment for patients of stage Ⅱ and Ⅲ colorectal cancer.Methods Eligible patients were randomly assigned to receive FOLFOX4 or FOLFOX4 plus rh-Endo regimen in which patients receiving 7.5 mg/m2 Ⅳ on day 1-7,repeated every 2 weeks,to a total of 12 cycles in 6 months.Results A total of 197 eligible patients were accrued in this research with 105 patients in the control group and 92 patients in the experimental arm.Median follow-up period was 42 months.The baseline characteristics distributed were balanced by treatment.Rh-Endo combined with FOLFOX4 regimen resulted in significant improvement on DFS compared to FOLFOX4 regimen for patients with stage Ⅲ colon cancer (HR =0.19,95％ CI0.05-0.75,P =0.0124),and with a 34％ improvement on 3-year DFS and 81％ reduced recurrence.Although rh-Endo combined with FOLFOX4 regimen failed to make significant difference on DFS in the whole (HR =0.75,95％ CI 0.31-1.83,P =0.5589),it was also observed a 17％ improveiment on 3-year DFS.No statistical significant difference on DFS was observed in patients with stage Ⅱ disease.Conclusions Rh-Endo combined with FOLFOX4 regimen significantly improved the disease-free survival for patients with stage Ⅲ colorectal cancer,indicating that patients with stage Ⅲ disease,but not stage Ⅱ disease,can benefit from FOLFOX4 plus rh-Endo regimen in adjuvant treatment.

Objective:To explore the application of high-throughput sequencing (HTS) technology in pathogens detection for spinal infection.Methods:From January 2019 to May 2020, a total of 41 patients including 31 males and 10 females with an average age of 59.7±11.9 years (29-75 years) were suspected of spinal infections. There were 37 patients with local pain, 15 with fever (≥38 ℃) and 18 with neurological dysfunction. The infected sites were as follows, 4 cases of cervical spine, 8 cases of thoracic spine and 29 cases of lumbar spine. There were 36 patients met the surgical indications and underwent open debridement, bone grafting, fusion and internal fixation, while the other 5 patients underwent conservative treatment (three received drug therapy and two were transferred to the internal department for chemotherapy). Lesions obtained from open surgery patients were underwent pathology and HTS examination. In 5 cases with conservative treatment, two of them underwent CT guided percutaneous puncture for samples, while one case underwent ultrasound guided percutaneous puncture for pus, one case for venous blood, and one case received lumbar puncture for cerebrospinal fluid. The samples were sent for pathological and HTS examination, while liquid specimens were sent for bacterial culture and HTS. The sensitivity and specificity of HTS results were determined according to pathological examination which was regarded as the "gold standard". Based on HTS results combined with the clinical manifestations, imaging examination and pathological results of the patients, targeted antibiotics or anti-tuberculosis drugs were selected for postoperative drug therapy. Patients with bacterial infection received anti-infection treatment for 3 months after operation. For tuberculosis patients, "tetrad" (isoniazid+rifampicin+pyrazinamide+ethambutanol) anti-tuberculosis treatments were underwent for one year. Inflammation indicators from the blood samples were observed before and after treatment, including white blood cell count (WBC), C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR). These indicators were used to monitor disease progression and the curative effects. All patients were followed up for at least 3 months after surgery.Results:A total of 41 patients with suspected spinal infection were included in this study. The HTS pathogen detection results were obtained within 48 h. For the initial 5 patients, first-generation sequencing verification was conducted with coincidence rate 100%. Further, no further verification was conducted in the rest patients. Among the 41 cases, a total of 26 cases had positive results with a positive rate of 63.4%(26/41). Among them, thirteen cases were with mycobacterium tuberculosis (31.7%) and 6 cases with staphylococcus (14.6%). Fungi and Brucellosis were diagnosed in 2 cases respectively, accounting for 4.9% respectively. The test were negative in 15 patients (36.6%), including 2 patients with tumor or tumor-like lesions (1 hematologic tumor and 1 eosinophilic granuloma). A total of 38 patients underwent pathological examination, which confirmed 7 cases of suppurative infection, 12 cases of tuberculosis, 2 cases of tumor or tumor-like lesions and the remaining 17 cases of inflammatory lesions. The sensitivity and specificity of HTS were 80%(16/20) and 55.6% (10/18) with positive predictive value (PPV) 66.7% (16/24) and negative predictive value (NPV) 71.4% (10/14). All patients were followed up for 3 months. The inflammation indicators of blood at 3 months were all lower than that at admission. WBC decreased from (7.50±3.26)×10 9/L at admission to (6.22±2.53)×10 9/L at 3 months after treatment without statistically significant difference ( t=1.082, P=0.290). The CRP decreased from (32.2±34.1) mg/L to (4.5±10.5) mg/L, and ESR from (44.2±26.5) mm/1 h to (18.6±12.1) mm/1 h with statistically significant difference ( t=8.963, P<0.001; t=5.421, P<0.001). Conclusion:High-throughput sequencing technology can be used in detection of spinal infection pathogens, due to its relatively high positive rate, satisfied sensitivity and good diagnostic value.

Objective To explore if any rules in electrocardiogram changes after transcatheter closure of perimembranous ventricular septal defects ( PMVSD ) . Methods We included all the 358 patients who have accepted transcatheter closure of PMVSD in our hospital between July 2006 to October 2014 and the electrocardiogram (ECG) done in hospital and during follow up in 1,3, 6 and 12 months after operation were all reviewed. Results No changes were found in heart rates and electrical axis during follow-up as compared to preclosure ECG. PR interval was shorter, the QRS duration and QT interval were longer than preclosure. Incidence rate of arrhythmia was 38. 0% ( 136/358 ) and incidence rate of serious arrhythmias ( including Ⅱ° or Ⅲ° atrioventricular block and complete left bundle branch block) was 5. 0%(18/358). Among the 180 patients who had ECG done in all follow up between the first 12 months post closure, the rates of new developed arrhythmias was 12. 8% ( 23/180 ) and severe arrhythmia was 0. 6%(1/180) during follow-up. Conclusions Incidence rate of serious arrhythmias after transcatheter closure of PMVSD is low and most patients have good clinical outcome.

Objective To evaluate the difference in coronary microcirculation and short term prognosis in patients with different collateral circulation and underwent elective percutaneous coronary intervention ( PCI) with complete occlusion of coronary artery. Methods The study included 42 patients who had been admitted in our hospital for NSTEMI or STEMI between 01/2012 to 12/2015 without receiving revascularization treatment and whose symptoms persisted for over 6 months. According to the results of coronary angiography and the Rentrop grade, the patients were divided into 2 groups: poor collateral circulation formation group (group A, Rentrop=0 -1, n=17) and well established collateral circulation group (group B, Rentrop=2-3, n=25). The basic clinical data and the result of coronary angiography were compared. A pressure-temperature sensor wire was used to measure index of mierocirculatory resistance ( IMR) immediately after PCI. An echocardiograph was used to measure left ventricular end systolic diameter ( LVEDd) and left ventricular ejection fraction ( LVEF) postoperatively and again at 3 months after operation to evaluate the changes in cardiac function. Results The IMR value of group A was significantly higher than group B (P﹤0. 05), the grade of collateral circulation had negative correlation with IMR value (r=-0. 671, P﹤0. 05). The mean changes in LVEDd in 3 months in group B was -0. 28 mm, while in group A was 5. 76 mm (P﹤0. 05). The mean changes in LVEF in 3 mouths in group B was 5. 36% and in group A was -3. 82% (P﹤0. 05). The grading of coronary collateral circulation had negative correlation with the changes of LVEDd in 3 months (r= -0. 669, P﹤0. 05), but had positive correlation with the changes of LVEF (r=0. 657, P ﹤0. 05). The IMR value had positive correlation with the changes of LVEDd in 3 months (r=0. 686, P﹤0. 05), but had negative correlation with the changes of the LVEF (r= -0. 664, P﹤ 0. 05 ) . Conclusions Patients with poor collateral circulation was more prone to coronary microcirculatory injury than patients with good collateral circulation. Patients with good collateral circulation and microcirculation had better prognosis after the revascularization of the infarction-related vessel.